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671 Selva Lakes Cir 2013 paver patio .5% , . CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD 07 ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00003669 Date 11/20/13 Property Address . . . . . . 671 SELVA LAKES CIR Application type description RESIDENTIAL OTHER Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 6251 ---------------------------------------------------------------------------- Application desc paver patio in rear ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ ROBERT, JOHN A OWNER 671 SELVA LAKES CIR ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . RESIDENTIAL ALT/OTHER Additional desc . . Permit Fee . . . . 85 . 00 Plan Check Fee 42 . 50 Issue Date . . . . Valuation . . . . 6251 Expiration Date . . 5/19/14 ---------------------------------------------------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONA1 ELECTRIC CODE ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 85 . 00 85 . 00 . 00 . 00 Plan Check Total 42 . 50 42 . 50 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 131 . 50 131 . 50 . 00 . 00 PERMIT IS APPROVED ONLV IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION P � 9 � 0 W � CITY OF ATLANTIC BEACH Lig 1 800 Seminole Road, Atlantic Beach, FL 32233 NOV 3 2013 Office (904)247-5826 Fax (904) 247-5845 JobAddress: &31 SGLVA LAKe-5 Qikoke Permit N by Legal Description Floor Area of S Ft. Parcel Sq Pt Valuation of Work$(A�1.%'1 Proposed Work 'Oea- ted/cooled non-heated/cooled 14'45saic& Class of Work(circle one): (Ee::w- Alteration Move Demolition pool/spa window/door Addition Repair Use of existing/proposed structure(s) circle one): Commercial &esidential) If an existing structure,is a fire sprinMr system installed? (Circle one): Yes No /A) Florida Product Approval# For multiple products use product approval form 7 Describe in detail the type of work to be performed: jI.ALit�70- j)A­1-a; k 7� J. rii r Puy I to- &- WWI I Property Owner Information: Name: ROAQLT +CA&()L�jPjt7_ _1014.0 Address: G 11 SELVA LAKC cl';t�� City Anp---nL dapco- State A_Zip_34a-�Phon�q o q) 96a, 14-1 E-Mail or Fax#(Optional) Pqoejt5P_T. Contractor Information: CQ>�MACTQR EMAIL ADDRESS: Company Name: Xr- Qualifying Agent: fteAe-Ai_ L,�L4,. Address. city State zi Office Phon"e flo4i Vjr- o asq-7 Job , 04 (4 Fax -1-:1=111=11:111 J c iop r istrati State Certif, at eg on JAEA r%,4 ri rr=9' Architect Na P one A�t'h ;!0— ODEeop Engineer's�Ke_�Pho e# CM Of*TLUMC MPtLVLN u itle r Fee Simple itle Holde am nd Address N BEACH Bonding Company Name Address (�V'f 7;_-W PeRmm MIZ X,.UrrONAL Mortgage Lender Name and Address W�!� "ClUIR ghdt&F.Ps AND MmmONS. I REVIEWEDBY. 4pplication is hereby made to obtain a permit to do the work an n N�a'm' n d A e Addres 4n e T' ��7­7e�Ta"=-rc-m7�,7hat commencedprior to the issuance cf a permit and that all work will be pe�jbrmed to meet th t5n taT , ![ -11 1 0 it becomes null and void iTwork is not commenced within six(6)months, or if construction or work is suspended or abandone or a er =t any time after work is commenced. I understand that separate permits must be securedfor Electrical Work,Plumbing, ns, S. oals, rnaces,Boilers, Heaters, Tanks and Air Conditioners,etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I;�hereb certify that I have read and exam i.ned this application and know the same to be true and correct. All provisions of laws and ordinances govern ing this P, 07,vork will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any otherjederal��sate, or local la regulating construction o, he performance of construction. r Signature of Ownerx�m�'�7 Z�'� Signature of Contractor Print Name Print Name A.8 ............. Befo!�W Before me i of 1:21 t:h I /1 . 20 this Day of 20 G Notary P jV Notary Public Q btuary 14,2014 ublic . z -",P1Rr:S -qg E ��t�ryPubllr;Underwr sondadTh t Tu Revised 01.26.10 CITY OF ATLANTIC BEACH E Copy ' (OWNER / ]BUILDER AFFIDAVIT, L 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW- DISCLOSURE STATEN4ENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERNUT UNDER AN EXEAPTION TO THAT LAW. THE EXENIPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR MROVE A ONE-OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR EVIPROVE A CONEAERCL&L BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS CONIPLETE, THE LAW WILL PRESUNM THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF TIES EXENIPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE ENDLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR NfUNICIPAL LICENSING ORDINANCES. 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. 111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENAL TY UNDER FLORIDA STATUTE NO. 455-228(l). AN-OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. (Ah SO-LiA LA49K CLO-cL8­ ADDRESS PHONE NUMBER (SIGNATURE Before me this /3day of V 20_L3 the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of )15�L_,County El Personally Known L t D Produced Ident! f 7NOLEY M 957760 Notary Si ture: 14,20 t4 Wndm Tt ;" . I Unde,writels F:/BLDG/O��-Bui�ld�Affada�i�t�Pj.---IVISED: 6/2009 NOTICE OF COMMENCEMEN FILE COPYA (PREPARE IN DUPLICATE) Permit No. -366 State of EL.,�, Tax Folio No. CouWy of A�,l�j To whom it may concern: The undersigned hereby Informs you that improvements will be made to certain real property,and In accordance with Section 713 of the Florida Statutes,the following Information is stated In this NOTICE OF COMMENCEMENT. Legal description of property being improved: SELdA i -.AKC-,,s GaCLC- %j8,rj-,jL �L--�V-0 (71,i,�L t so i,*,. -111 e A"Xv- V.v-,1) Address of,property being improved: 611 ISL-'L�LA Liq kC-� C i Act,�- 11 ZL AN 11 L!3u- General descript fion of improvements: AAVV�L 31DO ,4,A" Owner IQO&-,OF IjDr�i3 Address C-)4-1 LL? 1-0/4 bAke-s C1QCL(-- 111JAN-.1L Owner's interest in site of the improvement L-"�4�-L-- Fee Simple Titleholder(if other than owner) Name Address Contractor Address Phone No. Fax No. Surety(if any) Address Amount of bond Phone No. Fax No. Name and address of any person making a loan for the construction of the improvements. Name Address Phone No. Fax No. Name ofperson within the State of Florida,other than himself,designated by owner uponwhorn notices or other documents may be served: Name Address Phone No. Fax No. In addition to himself,owner designates the following person to rece,�ve a copy of the Lienor's Notice as provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's option). Name !VQ.-Ji� Address Phone No. Fax No. Expiration date of Notice of Commencement(the expiration date Is one(1)year from the date of recording unless a different date Is speeffled): THIS SPACE FOR RECORDEWS USE ONLY OWNER Signed: DATE Before r�o this _L-�__day of A?/Tj -&Ir?j in the CalOf Duval.State of Florida,has personalty appeared vpl:�Lk �2im44 -------tLere1 b SAN K.SUI himset herselfand affirms that all statements and declarations her su -L'VA Doc#2013290420,OR SK 16595 Page 909, are trucf!and aocurate Le of IV rid', NotarY Public,St8l Number Pages:1 My Comm.Expires Aug. 201 Recorded 1111 3i2013 at 02:14 PM, K CIRCUIT COURT DUVAL Commission No.EE 10 100 Ronnie Fussell CLER COUNTY cul Rotary Publiu at Large,State of 11`�L- County of a�,LvAi- RECORDING$10 00 My oommission expires: kA7 tL�, Z".15' FersonaliyKnown or Produred Identification P L- -J YX --7 t,-i -7o SELVA LAKES CIRCLE (o 0 , R1 kv.) 411 P.C. -7 COPY S-7 10-63 p. P. LLJ V) ni, < w -71 co CD 0 kAi k� lz kr)c') \T 00 f4 0 z 4 x ol WOOD FENCE x .34-.50' lip S83-4-2- 00"W THE P AZ A (80' R/W) S&�V V4f -A0 UA10A r16 W.. S&�Vycy 9 -9 7 DIRECTION MELI THAT THIS SURVEY PERFORMFD UNDER my RESPONSIBLE I jr,17-0, FLC I HEREBY CERTIFY �CCORDANCE YATH CHAPTER 13 AUM TECHNICAL STANDARDS FOR LAND SU�vEYORS IN A mIN4 472.027, FLORIDA STATUTFS), AND FURTHER CERTIFY ADMINISTRATIVE CODE (PURSUANT TO SECTION THE SUBjEcT PROPERTY EXCEPT AS SHO�M -NTS UPON T"FpF ARE NO VISIBLE ENCROACHMF DOD CLARSON AND ASSoC'A'V- FLOOD CERWICATE, THE Lor sHOm HEREON is IN FU la43 MALDO AVE,, JACKSONWI-E, FL, AS SHOYM ON THE FLOOD INSURANCE RATE ZONE OOOID , E)ATED4-17-59- MAP, COMMUNITY PANEL NO. izQO7!5 'r SURvEYED �Eo SU�RV �� SCALE: 1" = 20' 74 JoSE A. HILL F-IFLI) BOOK_ 537 PAGF 5,50 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 o, Phone(904) 247-5826 - Fax(904)247-5845 - // A3//-F E-mail: building-dept@coab.us Date routed. Cityweb-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ell— D rtment review required Yes,-No r Applicant: Planning &Zoning or ftreerra or Public Works Project: Public Utilities Public Safety Fire Services Review fee $ Dept Signature Review or Receipt Other Agency Review or Permit Required of Permit Verified By Date Florida Dept. of Environmental Protection Florida Dept.of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review-: MA-pproved.. E]Denied. (Circle one.) Comments: (E�D:1N 6) PLANNING&ZONING Reviewed by: Date: =1�d TREEADMIN. Second Review: FlApproved as revised. r ID ied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: RApproved as revised. DIDenied. Comments: Reviewed by: Date: Revised 07/27/10 City of Atlantic Beach APPLICATION NUMBER (To be assigned by the Building Department Building Department 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904) 247-5826 - Fax(904)247-5845 Late routed: E-mail: building-dept@coab.us Cityweb-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: el'z- D 4 * rtment review required Yes No Planning &Zoning Applicant: o L'�)-;r) r d­AdIffiThMtCdtor Public Works Project: Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Re iew or Receipt Date of Permit Verified By F Florida Dept. of Environmental Protection Florida Dept. of Transportation vLi—u;--- Yes rtmenty revview requirledU7 rt_1_ r_to eCAdm Mttta r Review or Receipt ther Ag en cy Review or Permit Required of P ermit Ve rified By londa Dept of Envi ro nmental Protection F lon da Dept of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLI ION STATUS Reviewing Department First Review: pproved. E]Denied. I'A 'ON STATU F�__ Z ' _ pprov ed. (Circle one.) Comments: f IF f%�,p i) A 1�h er TjaA '30 cc(eq se— &Y;1�/<,P— BUILDING <,A&dc ov 4��_ Date: PLANNING &ZONING Reviewed by4: 40 TREE ADMIN. Second Review: FlApproved as revised. []Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: RAPproved as revised. FIDenied- Comments: Reviewed by: Date: Revised 07/27110